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The COVID-19 pandemic is putting enormous pressure on the healthcare system. This is partly due to the explosion in the number of cases and partly because healthcare professionals are getting sick, in some cases fatally succumbing to the virus.
While medical students are not full-fledged physicians, we do have a wealth of clinical training and knowledge. As such, we could be used more effectively. We should consider physicians-in-training as welcome partners for more experienced physicians and nurses, especially given the rate of increase in infection rates in the United States. The only thing that prohibits the use of such valuable and valuable manpower is the lack of planning and strategic foresight. To address this need for physicians, some institutions have taken a reactionary approach by pushing graduation a few months earlier, making them a MD a little prematurely. However, this approach is not exhaustive.
Taking a lesson from Italy's experience, the United States must avoid partial solutions. The reality is that, even with the first transfers of titles, most medical institutions have neglected tens of thousands of pairs of hands that are trained and ready to support. While awarding degrees earlier is a significant approach, it is defensive in nature. To turn that into an offensive strategy, we must utilize medical students who are further away from graduation and put them in roles consistent with their full training. A significant benefit of this would be the ability to reassign experienced physicians to care for patients affected by the outbreak while keeping medical students largely out of harm's way.
At the beginning of their clinical years, medical students have already been assessed on their ability to take a history, identify a differential diagnosis, and perform a basic physical examination. By the time medical students enter their fourth year, they have learned to identify and manage patients with common problems (eg, high blood pressure, diabetes, COPD). In addition, they can interpret common laboratory results and basic radiological images, and document patient notes and discharge summaries in the electronic medical record (EMR). In fact, in some hospitals, once confirmed by a senior physician, a medical student can order medication and have their patient notes used for billing.
Also, before medical students graduate, they have passed two of the three exams required to be a board certified physician. These points are important because junior and senior physicians-in-training are highly trained but are an underutilized resource in a health crisis.
With that in mind, human resource strategies to address the COVID19 pandemic should involve:
Assignment of medical students to provide care in routine non-emergent settings and scenarios consistent with their full level of training. Early clinical training students are to provide primarily indirect care, i.e. callbacks to outpatient clinics, telephone triage for hospitals or clinics, researching up-to-date virus treatment guidelines for physicians, endowing state and local health departments , to taking the history and physical exams in the clinics. Fourth year students are required to provide direct and indirect care in non-emergent routine settings. Duties consistent with management in internal medicine. Additionally, medical students should be used as providers of care in non-traditional inpatient settings, such as rehabilitation centers and skilled nursing facilities.
Pairing of medical students with experienced and retired physicians, similar to the tactic used by the UK National Health Service. The convenience of EMR medical students and familiarity with clinical sites can increase efficiency and accuracy for clinicians with advanced clinical acumen.
This is how we can execute these strategies:
Hire medical students and categorize them as temporary hospital employees, with specific locations for their full level of training. Hospitals have been open about a shortage of medical supplies and staff, and at least one hospital system has offered to temporarily hire medical students through an expedited recruitment process for "known and trusted students."
Draft medical students as part of a state health disaster response body and temporarily deploy them to facilities where they are needed. There are several medical students who are technically enlisted service men and women, but most of us are not. In a global health crisis like this, we really should consider at least a voluntary state health service draft that includes a role specific to the skills of a medical student.
As a fourth-year medical student, I am sure I am not alone when I share my frustration at the lack of formal planning on how to safely and effectively leverage medical student training. There are some provisions that allow flexibility in licensing requirements and regulations when a surge of healthcare professionals is needed, many initiated after major disasters such as H1N1 flu, Superstorm Sandy, and Hurricane Katrina.
Unfortunately, the American Association of Medical Schools (AAMC) has not included in its COVID-19 resources any formal plans on how to safely and effectively leverage the clinical training of even fourth-year medical students. However, there is still time to implement a preparedness plan that allows capable students to support and serve in this growing crisis.
